Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study.

BACKGROUND: Many people with epilepsy in low-income countries do not receive appropriate biomedical treatment. This epilepsy treatment gap might be caused by patients not seeking biomedical treatment or not adhering to prescribed antiepileptic drugs (AEDs). We measured the prevalence of and investigated risk factors for the epilepsy treatment gap in rural Kenya. METHODS: All people with active convulsive epilepsy identified during a cross-sectional survey of 232,176 people in Kilifi were approached. The epilepsy treatment gap was defined as the percentage of people with active epilepsy who had not accessed biomedical services or who were not on treatment or were on inadequate treatment. Information about risk factors was obtained through a questionnaire-based interview of sociodemographic characteristics, socioeconomic status, access to health facilities, seizures, stigma, and beliefs and attitudes about epilepsy. The factors associated with people not seeking biomedical treatment and not adhering to AEDs were investigated separately, adjusted for age. FINDINGS: 673 people with epilepsy were interviewed, of whom 499 (74%) reported seeking treatment from a health facility. Blood samples were taken from 502 (75%) people, of whom 132 (26%) reported taking AEDs, but 189 (38%) had AEDs detectable in the blood. The sensitivity and specificity of self-reported adherence compared with AEDs detected in blood were 38·1% (95% CI 31·1-45·4) and 80·8% (76·0-85·0). The epilepsy treatment gap was 62·4% (58·1-66·6). In multivariable analysis, failure to seek biomedical treatment was associated with a patient holding traditional animistic religious beliefs (adjusted odds ratio 1·85, 95% CI 1·11-2·71), reporting negative attitudes about biomedical treatment (0·86, 0·78-0·95), living more than 30 km from health facilities (3·89, 1·77-8·51), paying for AEDs (2·99, 1·82-4·92), having learning difficulties (2·30, 1·29-4·11), having had epilepsy for longer than 10 years (4·60, 2·07-10·23), and having focal seizures (2·28, 1·50-3·47). Reduced adherence was associated with negative attitudes about epilepsy (1·10, 1·03-1·18) and taking of AEDs for longer than 5 years (3·78, 1·79-7·98). INTERPRETATION: The sensitivity and specificity of self-reported adherence is poor, but on the basis of AED detection in blood almost two-thirds of patients with epilepsy were not on treatment. Education about epilepsy and making AEDs freely available in health facilities near people with epilepsy should be investigated as potential ways to reduce the epilepsy treatment gap. FUNDING: Wellcome Trust

Aspects determining the risk of pesticides to wild bees: risk profiles for focal crops on three continents

In order to conduct a proper risk assessment of pesticides to bees, information is needed in three areas: the toxicity of the pesticide;the probability of bee exposure to that pesticide; andthe population dynamics of the bee species in question.Information was collected on such factors affecting pesticide risk to (primarily wild) bees in several crops in Brazil, Kenya and The Netherlands. These data were used to construct ‘risk profiles’ of pesticide use for bees in the studied cropping systems. Data gaps were identified and potential risks of pesticides to bees were compared between the crops. Initially, risk profiling aims to better identify gaps in our present knowledge. In the longer term, the established risk profiles may provide structured inputs into risk assessment models for wild and managed bees, and lead to recommendations for specific risk mitigation measures. Keywords: pesticide, exposure, risk, wild bees, risk profil

Modelling the relationship between malaria prevalence as a measure of transmission and mortality across age groups

Parasite prevalence has been used widely as a measure of malaria transmission, especially in malaria endemic areas. However, its contribution and relationship to malaria mortality across different age groups has not been well investigated. Previous studies in a health and demographic surveillance systems (HDSS) platform in western Kenya quantified the contribution of incidence and entomological inoculation rates (EIR) to mortality. The study assessed the relationship between outcomes of malaria parasitaemia surveys and mortality across age groups.; Parasitological data from annual cross-sectional surveys from the Kisumu HDSS between 2007 and 2015 were used to determine malaria parasite prevalence (PP) and clinical malaria (parasites plus reported fever within 24 h or temperature above 37.5 °C). Household surveys and verbal autopsy (VA) were used to obtain data on all-cause and malaria-specific mortality. Bayesian negative binomial geo-statistical regression models were used to investigate the association of PP/clinical malaria with mortality across different age groups. Estimates based on yearly data were compared with those from aggregated data over 4 to 5-year periods, which is the typical period that mortality data are available from national demographic and health surveys.; Using 5-year aggregated data, associations were established between parasite prevalence and malaria-specific mortality in the whole population (RR; malaria; = 1.66; 95% Bayesian Credible Intervals: 1.07-2.54) and children 1-4 years (RR; malaria; = 2.29; 1.17-4.29). While clinical malaria was associated with both all-cause and malaria-specific mortality in combined ages (RR; all-cause; = 1.32; 1.01-1.74); (RR; malaria; = 2.50; 1.27-4.81), children 1-4 years (RR; all-cause; = 1.89; 1.00-3.51); (RR; malaria; = 3.37; 1.23-8.93) and in older children 5-14 years (RR; all-cause; = 3.94; 1.34-11.10); (RR; malaria; = 7.56; 1.20-39.54), no association was found among neonates, adults (15-59 years) and the elderly (60+ years). Distance to health facilities, socioeconomic status, elevation and survey year were important factors for all-cause and malaria-specific mortality.; Malaria parasitaemia from cross-sectional surveys was associated with mortality across age groups over 4 to 5 year periods with clinical malaria more strongly associated with mortality than parasite prevalence. This effect was stronger in children 5-14 years compared to other age-groups. Further analyses of data from other HDSS sites or similar platforms would be useful in investigating the relationship between malaria and mortality across different endemicity levels

Accelerated variety turnover for open-pollinated crops in Tanzania - Phase 1 Key Findings

Open-pollinated varieties (OPVs), such as beans, sorghum, and groundnuts, are important for increased income, job creation, food security, and nutrition of both urban and rural households in sub-Saharan Africa (SSA). However, the main constraint is underdeveloped seed systems, which contribute substantially to dwindling productivity among small-scale farmers due to limited access to reliable and quality planting materials. ACCELERATE is expected to accelerate varietal adoption and turnover in Tanzania by tapping into the power of large/small-scale or marketplace traders, and institutional seed buyers

Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study.

BACKGROUND: Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS: We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS: Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS: Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Theatre for development in Kenya : in search of an effective procedure and methodology

Thesis (DPhil)--University of Stellenbosch, 2004.ENGLISH ABSTRACT: This is a study of Theatre for Development (TfD) in Kenya. It is an attempt to map out and describe different manifestations of the practice which would, in a way, act as a critical model for practitioners and other stakeholders. However, this is in no way an attempt to provide a rigid all-purpose theoretical model, but nonetheless to offer ways, through a description of aspects of Theatre for Development, within which and through which social and behavioural transformations in this eclectic field may take place. To this end, case studies of a few indicative and contrasting examples of Theatre for Development will be used to provide a mirror which will enable its practitioners to reflect upon and critique their own practices as a way of achieving optimum effectiveness. The works of Paulo Freire and Augusto Boal provide the study with a theoretical model in which its basic assumptions and arguments are tested and developed. These two authors, whose works are related in many ways, privilege the use of participatory approaches in the process of creating critical consciousness and promoting change in the individual and in society; these are fundamental requirements in any meaningful practice of Theatre for Development. The findings of this study reveal the discursive and eclectic state of the practice of Theatre for Development in Kenya as originating from a multiplicity of factors such as the skills (or lack thereof) of the practitioners, government interference and the prescriptive agenda and demands of the project funding bodies, institutions and agencies as well as the proliferation of NGOs using Theatre for Development but lacking its foundational philosophy and methodology. This study therefore suggests that, for the enterprise to be more effective and efficient there is a serious need to reflect critically on its procedures and methodology in order to improve and guide its operation. These fundamental aspects include collaborative research, codification, interactive participation, and facilitation and intervention, and are not prescriptive matters but descriptive, arrived at through a critical analysis of a number of Theatre for Development activities in Kenya. Ultimately the research process has thus highlighted a number of weaknesses and strengths in the practice of Theatre for Development in Kenya. Because Theatre for Development is a performance event, the study utilised both quantitative and qualitative research methods. This was necessary, because the study depended on a bibliographical review, unstructured interviews and action research, where the researcher participated in Theatre for Development projects, happenings and related activitiesAFRIKAANSE OPSOMMING: Hierdie is ‘n ondersoek na Teater vir Ontwikkelling in Kenya. Dit poog om die verskillende manifestasies van die praktyk te karteer en beskryf waardeur dit, tot ‘n mate, a kritiese model vir praktisyns en aandeelhouers kan dien. Die onderneming is egter op geen wyse ‘n soeke na ‘n rigiede, allesomvattende teoretiese model nie, maar bied tog ‘n beskrywing van aspekte van Teater vir Ontwikkelling waarbinne en waardeur transformasie van sosiale optrede en handeling in hierdie eklektiese veld kan plaasvind. Met dit in gedagte word na ‘n aantal toepaslike en kontrasterende gevallestudies van Teater vir Ontwikkelling gekyk om ‘n perspektief te ontwikkel wat praktisyns in staat sal stel om hulle eie praktyke krities en effektief te kan evalueer. Die werk en geskrifte van Paulo Freire en Augusto Boal verskaf die teoretiese model vir hierdie ondersoek, wat die basiese beginsels en uitgangspunte daarvan in die Afrika-konteks uittoets en ontwikkel. Hierdie skrywers, wie se werke nou verband hou met mekaar, gee voorkeur aan ‘n interaktiewe, deelnemende benaderings tot die ontwikkelling van ‘n kritiese bewussyn en die stimulering van verandering by die individu en in die gemeenskap. Dié benaderings is fundamenteel tot enige sinvolle aanwending van Teater vir Ontwikkelling. Daar is bevind dat die beoefening van Teater vir Ontwikkelling in Kenia uiters eklekties en uiteenlopend van aard is en dat hierdie stand van sake toegeskryf kan word aan ‘n verskeidenheid faktore, insluitend die vaardighede (of tekort aan vaardighede) van praktisyns, inmenging deur die regering, voorskriftelike agendas en vereistes gestel deur borge en befondsingsagentskappe, edm. ‘n Ander faktor is die geweldige toename in nie-regeringsorganisasies (NGO’s) wat van Teater vir Ontwikkelling gebruik maak terwyl hulle nie oor die basiese filosofiese en metodologiese kennis en opleiding beskik nie. Die bevinding is dus dat sodanige programme slegs meer effektief en doeltreffend bedryf kan word indien daar ernstig besin word oor fundamentele prosedures en metodologieë, om aan die verdere bedryf van die program(me) rigting te kan gee en uitkomste te verbeter. Fundamentele aspekte hierby betrek sou insluit spannavorsing, samewerking, kodifisering, interaktiewe deelname, fasilitering en intervensie, wat nie voorskriftelik is nie, maar beskrywend en rigtinggewend van aard, afgelei uit ‘n kritiese ontleding van ‘n aantal Teater vir Ontwikkelling aktiwiteite in Kenia. Die navorsing het dus uiteindelik ‘n aantal sterk- en swakpunte in die praktyk van Teater vir Ontwikkelling in Kenia belig. Omdat Teater vir Ontwikkelling ‘n aanbiedings-gebeurtenis (“performance event”) is, het die ondersoek beide kwantitatiewe en kwalitatiewe navorsingsmetodes gebruik. Dit was nodig omdat die ondersoek gebruik gemaak het van formele literatuurstudie, sowel as ongestruktureerde onderhoude en aksienavorsing, waartydens die navorser self deelgeneem het aan van die Teater vir Ontwikkelling projekte, gebeure en aktiwiteite

Estimating a Finite Population Mean Using Transformed Data in Presence of Random Nonresponse

Developing finite population estimators of parameters such as mean, variance, and asymptotic mean squared error has been one of the core objectives of sample survey theory and practice. Sample survey practitioners need to assess the properties of these estimators so that better ones can be adopted. In survey sampling, the occurrence of nonresponse affects inference and optimality of the estimators of finite population parameters. It introduces bias and may cause samples to deviate from the distributions obtained by the original sampling technique. To compensate for random nonresponse, imputation methods have been proposed by various researchers. However, the asymptotic bias and variance of the finite population mean estimators are still high under this technique. In this paper, transformation of data weighting technique is suggested. The proposed estimator is observed to be asymptotically consistent under mild assumptions. Simulated data show that the estimator proposed is much better than its rival estimators for all the different mean functions simulated

Estimation of a Finite Population Mean under Random Nonresponse Using Kernel Weights

Nonresponse is a potential source of errors in sample surveys. It introduces bias and large variance in the estimation of finite population parameters. Regression models have been recognized as one of the techniques of reducing bias and variance due to random nonresponse using auxiliary data. In this study, it is assumed that random nonresponse occurs in the survey variable in the second stage of cluster sampling, assuming full auxiliary information is available throughout. Auxiliary information is used at the estimation stage via a regression model to address the problem of random nonresponse. In particular, auxiliary information is used via an improved Nadaraya–Watson kernel regression technique to compensate for random nonresponse. The asymptotic bias and mean squared error of the estimator proposed are derived. Besides, a simulation study conducted indicates that the proposed estimator has smaller values of the bias and smaller mean squared error values compared to existing estimators of a finite population mean. The proposed estimator is also shown to have tighter confidence interval lengths at 95% coverage rate. The results obtained in this study are useful for instance in choosing efficient estimators of a finite population mean in demographic sample surveys